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Objective:To explore the best negative pressure standard of sputum aspiration in patients with severe craniocerebral injury, so as to achieve the best sputum aspiration effect and maintain relatively stable intracranial pressure.Methods:Totally 120 patients with severe craniocerebral injury admitted to the Department of Neurosurgery of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January to December 2019 were selected by convenience sampling method. According to the random number table method, patients were divided into 4 different negative pressure sputum aspiration groups: 75 mmHg (1 mmHg=0.133 kPa) group, 100 mmHg group, 150 mmHg group, 200 mmHg group, with 30 patients in each group. The levels of intracranial pressure and SpO 2, sputum cleaning time and mucosal injury were observed and compared in 4 groups: 1 min before sputum aspiration, 1 min after sputum aspiration and during sputum aspiration. Results:Comparison of intracranial pressure and SpO 2 in sputum aspiration among the four groups: intracranial pressure in 200 mmHg group was (22.23 ± 4.80) mmHg, which was higher than 75 mmHg group (16.33 ± 2.71) mmHg, 100 mmHg group (17.70 ± 2.32) mmHg, 150 mmHg group (17.20 ± 2.11) mmHg ( q=8.29, 6.58, 7.23), and SpO 2 was 0.906 ± 0.048, which was lower than 0.956 ± 0.013, 0.946 ± 0.018, 0.952 ± 0.023 in the other three groups ( q=7.81, 6.08, 6.69), with statistical significance (all P<0.01). There were statistically significant differences in intracranial pressure ( F=10.55) and SpO 2 ( F=36.57) among the four groups 1 min after sputum aspiration ( P<0.01);the 200 mmHg group had the highest intracranial pressure (15.63 ± 3.64) mmHg; the 100 mmHg group was (12.50 ± 1.48) mmHg and 150 mmHg group was (12.60 ± 1.00) mmHg, which had lower intracranial pressure than the 75 mmHg group (14.03 ± 2.86) mmHg. The sputum cleaning time was (35.53 ± 5.71) s in 75 mmHg group which was the longest and the shortest in 200 mmHg group (24.27 ± 3.22) s, with statistical significance among the four groups ( F=47.81, P<0.01). The incidence of airway mucosal injury in 200 mmHg group was 33.33% (10/30),which was higher than that in the other three groups, and the difference was statistically significant ( χ2=15.41, P<0.01). Conclusions:For patients with severe craniocerebral injury, artificial airway sputum viscosityⅠ-Ⅱ degree, suction negative pressure of 100-150 mmHg can better maintain the stability of intracranial pressure, control the decline of SpO 2 and prevent the damage of airway mucosa, and effectively reduce the adverse effects of sputum aspiration on patients with severe craniocerebral injury.
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Ventilator-associated pneumonia (VAP) is one of the most common infectious diseases in patients undergoing mechanical ventilation in intensive care unit (ICU). Although the use of closed sputum suction tube for sputum suction is the most common nursing measure for patients with tracheal intubation in ICU, and it is also an important measure to reduce the occurrence of VAP, the existing clinical technology still needs to use external flushing solution for humidification and flushing. In the process of use, the flushing operation has the risk that the amount of flushing fluid cannot be controlled, resulting in a large amount of flushing fluid entering the patient's airway, causing the patient to suffocate. The sputum attached to the wall of the sputum suction tube cannot be completely flushed, and the prolonged retention of the sputum leads to the proliferation of colonized bacteria, aggravating the infection of patients. Repeated pipe flushing not only increases consumables, but also increases the workload of medical staff. For this reason, the author has designed a fully enclosed sputum suction tube flushing device, which has obtained the National Utility Model Patent of China (patent number: CN 2019 2 1198740.5). This device is an integrated design, and the materials used for sputum suction, humidification and flushing are fully enclosed, without air exposure, and can be operated strictly without bacteria. Pulse flushing with syringe can clean the sputum attached to the inner wall and reduce the incidence of VAP. The volume of flushing fluid can be effectively controlled during use to ensure patient safety and reduce waste. It is worth popularizing and applying in clinical practice to optimize the operation steps and reduce the workload of medical staff.
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A motion unit for sucking robot with a stable motion, convenient operation and process simulation is introduced. The key parameters and process data of the sucking operation were obtained from the clinical work, which provided the basis for the design of the sucking robot motion unit. According to the points of sucking action, robotic thumb, forefinger and metacarpophalangeal joints were used to grip the suction tube, and the servo and arm structure were used to simulate the motion of the wrist and elbow to complete the rotation and push of the sputum suction tube. The feasibility is verified through the advanced sputum suction training model. The movement unit is stable in movement, and can smoothly complete the clamping, feeding, back off protection and rotating tube removal of the sputum suction tube, so as to achieve effective sputum suction.
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Catheterization , Intubation, Intratracheal , Robotics , SuctionABSTRACT
Objective • To compare the efficacy and safety of propofol and dexmedetomidine in conscious sedation in post thoracic surgery patients undergoing flexible bronchoscopy suction sputum. Methods • A total of 90 post thoracic surgery patients who would receive suctioning sputum by fiberoptic bronchoscope were randomly divided into three groups, i.e. control group, propofol group, and dexmedetomidine group. The control group received intravenous injection of saline. A bolus dose of 1% propofol (0.4 mg/kg) followed by a 1-2 mg/(kg • h) continuous injection was applied in the propofol group. In the dexmedetomidine group, a bolus dose of dexmedetomidine (1 μg/kg) intravenously injected, followed by a 0.6 μg/(kg • h) continuous injection. The vital signs and Ramsay score were recorded before taking drugs, before sucking sputum, sucking sputum, sucking sputum immediately, 0.5 h after sucking sputum, and 1 h after sucking sputum. Difficulty in entering glottis, adverse events, and visual pain score were also recorded and compared. Results • Compared with the dexmedetomidine group, the heart rate and mean arterial pressure in the propofol group and the control group were higher before and after flexible bronchoscopy suction sputum (all P<0.05). Compared with the control group, the mean arterial pressure in the propofol group was lower before sucking sputum and sucking sputum immediately (both P<0.05). Compared with the control group, Ramsay sore in propofol group was higher before sucking sputum and sucking sputum (P=0.026, P=0.026), and Ramsay score in the dexmedetomidine group was higher before sucking sputum, 0.5 h after sucking sputum and 1 h after sucking sputum (P=0.015, P=0.000, P=0.000). The incidence of adverse events was lower in the dexmedetomidine group than that in the control group (P=0.004). The visual pain score was lowest in the propofol group and highest in the control group. Conclusion • Both dexmedetomidine and propofol can be used in conscious sedation during flexible bronchoscopy suction sputum after thoracic surgery. The use of propofol can make patients much more comfortable. Compared with propofol, patients with dexmedetomidine have a lower incidence of adverse events, and their heart rate and blood pressure are more stable during sputum suction. Therefore, dexmedetomidine may be more suitable for patients combined with cardiovascular disease.
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Objective To develop a kind of special einbrand for clinical sputum suction. Methods The einbrand was composed of two parts: a body penetrating the mouth and an external wing, which was made of self-lubrication paraformaldehyde. The body was small in size and easy to be put in the patient's mouth, and could effectively press the tongue.The bite surface was divided into two sections of plane and elliptic surface,the plane section facilitated the biting of the patient while the elliptic surface assisted to discharge the einbrand. The external wing executed positioning while the einbrand was put into the mouth,which could be held by one single hand for manipulation.Results Clinical trials proved that the einbrand was embedded into the mouth easily with the mouth opened 10 mm,that the einbrand was bitten by the patient in case the bite force was existent,that the einbrand was discharged when it was drawn out 35 mm or so,and that the einbrand could withstand the pressure higher than 12 kg/cm2(1 200 kPa)with no deformation.Conclusion The einbrand designed can be satisfactorily used for clinical sputum suction.
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Objective To investigate the impact of sputum suction under laryngoscope in stroke patients on the occurrence and prognosis of ischemic stroke-associated pneumonia (SAP).Methods A total of 127 cases with acute ischemic stroke (AIS) with Glasgow Coma Scale 6-12 scores,non-artificial airway and need for intensive care were enrolled.According to the suction practice,the cases were divided into laryngoscope euthyphoria group (practice group,PG,n =59),and conventional oral or nasal sputum suction group (control group,CG,n =68).The PG was perspectively studied,while the CG were analyzed retrospectively.All patients were cared with the Guidelines for the management of adult with hospitalacquired ventilator-associated and healthcare-associated pneumonia set by American Thoracic Society/Infectious Diseases Society of America in 2005 and the Guidelines for the early management of patients with acute ischemic stroke set by American Heart Association/American Stroke Association in 2013 including patting on the back of patients in prone position routinely in order to facilitating expectoration,phlegm elimination with physical vibration and apophlegmatic agent application during their stay in ICU.Incidences of SAP and 28-day mortality were calculated.Levels of inflammatory markers (white blood cell,WBC;highsensitive C-reaction protein;procalcitonin,PCT) in serum were detected.Adverse events related to laryngoscopy were documented.Results There were no significant differences in incidences of SAP and 28-day mortality between PG and CG groups (32.20％ vs.41.18％,P ＞ 0.05;47.37％ vs.53.57,P ＞ 0.05,respectively).However,there was statistically significant difference (P ＜ 0.05) in the ICU stay length and inflammatory markers,and the sputum suction process in PG did decrease the incidence of artificial airway establishment and mechanical ventilation (18.64％ vs.35.29％,P ＜ 0.05),and the laryngoscope euthyphoria method was proved to be a protective factor (HR =0.515;95％ CI 0.281-0.057,P =0.038).WBC and PCT were lower in PG group than in CG group (P ＜ 0.05).Conclusion Sputum suction under laryngoscope can reduce the probability of artificial airway establishment and invasive ventilator employment in patients with AIS,shortening ICU stay length and down-regulating levels of WBC and PCT.
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Objective To explore the application value of chlorhexidine combined with disposable combined type sputum suction tube in ventilator-associated pneumonia(VAP).To provide an effective method for prevention and control of hospital infection in ICU.Methods 104 patients with mechanical ventilation were randomly divided into the observation group(55 cases) and control group(49 cases).During the period of hospitalization,the incidence rates of oral infection and VAP of the two groups were observed.At the time of admission and in-hospital,clinical pulmonary infection scores (CPIS) of the two groups were evaluated.Results Oral herpes,ulcer incidence rates of the observation group were 3.64%,9.09%,which were lower than the control group,the differences were statistically significant (χ2 =4.802,4.494,all P<0.05).After 3 days and 7 days of mechanical ventilation,VAP incidence rates of the observation group were 3.64%,12.73%,which were lower than the control group,the differences were statisti-cally significant (χ2 =5.945,4.037,all P<0.05).After 3 days and 7 days of mechanical ventilation,the results of CPIS of the observation group were (4.94 ±0.76) points,(5.29 ±0.91) points,which were lower than the control group,the differences were statistically significant (t=3.812,3.295,all P<0.05).Conclusion The medical care of chlorhexidine combined with disposable combined type sputum suction tube showes significant effect on patients with mechanical ventilation,has high value in clinical application.
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Objective To investigate the effect of different sputum suction methods on the incidences of pulmonary infections in patients with mechanical ventilation.Methods Four hundred and sixty-six patients with mechanical ventilation were randomly divided into study group(n=219)and control group(n=247).The two groups were treated with continued balloon filling and airway humidification.Besides,the control group received conventional open sputum suction and the study group closed continuous negative pressure sputum suction.The two groups were compared in terms of incidence of pulmonary infections.Result The incidence of the study group(8.2%)was significantly lower than that of the control group(14.6%)(χ2=4.58,P<0.05).Conclusion Compared with the traditional open conventional sputum suction method,closed continuous negative pressure sputum suction may be more effective in reducing the incidence of pulmonary infection in patients with mechanical ventilation.